- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $112.38 / $416.06 / $772.05
| Facility | | $112.38 | $416.06 | $772.05 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $112.38 / $112.38 / $112.38
| Professional | | $112.38 | $112.38 | $112.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $106.74 / $109.78 / $344.08
| Facility | | $106.74 | $109.78 | $344.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $57.40 / $130.35 / $228.25
| Professional | | $57.40 | $130.35 | $228.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $124.87 / $143.60 / $505.72
| Facility | | $124.87 | $143.60 | $505.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $130.13 / $138.33 / $172.64
| Professional | | $130.13 | $138.33 | $172.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $52.45 / $52.45 / $74.92
| Professional | | $52.45 | $52.45 | $74.92 |